Hip Joint method

ABSTRACT

A surgical or arthroscopic method for resurfacing at least one surface of a hip joint of a human patient, using a medical device comprising an artificial hip joint surface, wherein the hip joint surface comprising an acetabulum surface and a caput femur surface, said method comprising the steps of: creating at least one hole passing into the hip joint, dissecting and preparing the hip joint, introducing at least one artificial hip joint surface, comprising at least one of an artificial acetabulum surface and an artificial caput femur surface, wherein said at least one artificial hip joint surface, comprising a first sealing member, creating a sealed hollow space between said first sealing member and one of the acetabulum surface or said artificial acetabulum surface and one of the caput femur surface or said artificial caput femur surface, selecting at least one artificial hip joint surface and injecting a material into said hollow space.

FIELD OF INVENTION

The present invention relates generally to a surgical orlaparoscopic/arthroscopic method of operating a hip joint of a humanpatient.

BACKGROUND

Hip joint Osteoarthritis is a syndrome in which low-grade inflammationresults in pain in the hip joints, caused by abnormal wearing of thecartilage that acts as a cushion inside if the hip joint. This abnormalwearing of the cartilage also results in a decrease of the jointslubricating fluid called Synovial fluid. Hip joint Osteoarthritis isestimated to affect 80% of all people over 65 years of age, in more orless serious forms.

The present treatment for hip osteoarthritis comprises NSAID drugs,local injections of Hyaluronic acid or Glucocorticoid to help lubricatethe hip joint, and replacing parts of the hip joint with a prosthesisthrough hip joint surgery.

The replacing of parts of the hip joint is one of the most commonsurgeries to date performed at hundreds of thousands of patients in theworld every year. The most common method comprises placing a metalprosthesis in femur and a plastic bowl in acetabulum. This operation isdone through a lateral incision in the hip and upper thigh and throughfascia lata and the lateral muscles of the thigh. To get access to thejoint, the supporting hip joint capsule attached to femur and ilium ofpelvis needs to be penetrated, making it difficult to get a fullyfunctional joint after the surgery. Femur is then cut at the neck with abone saw and the prosthesis is placed in femur either with bone cementor without. Acetabulum is slightly enlarged using an acetabular reamer,and the plastic bowl is positioned using screws or bone cement.

The surgery typically requires one week of hospitalization due to theincreased risk of infection. The recovery process is on average about 6weeks, but even after this period the patient should not perform anyphysical activates that places large strain on the joint.

It would therefor be desirable to have an operational method that couldspare the hip joint capsule and reduce the removal of healthy femurbone. It would further be preferable to have a method of operating thatcould shorten the time for recovery of the patient, and reducing theamount of affected large blood vessels, thus reducing the risk of bloodclots.

SUMMARY The Surgical and Laparoscopic/Arthroscopic Method

A first object is to provide a surgical and/or laparoscopic/arthroscopicmethod for treating a hip joint of a human patient by providing at leastone hip joint surface. The hip joint comprises a caput femur located onthe very top of the femur bone and an acetabulum, which is a part of thepelvic bone, the caput femur is in connection with the acetabulum.

The idea is to perform an operation in the hip joint through a hole inthe pelvic bone, however some of the aspects of the present inventioncan be performed using conventional surgery entering the hip jointthrough the hip joint capsule, or by entering through the femur bone.

The surgical method comprises the steps of cutting the skin of the humanpatient, dissecting an area of the pelvic bone on the opposite side fromacetabulum, creating a hole in the dissected area which passes throughthe pelvic bone and into the hip joint, and providing at least one hipjoint surface into the hip joint, through the hole in the pelvic bone.

According to one embodiment, the step of cutting the skin of the humanpatient could be performed in the abdominal wall, the inguinal area, thepelvic region or the abdominal region of the patient.

The laparoscopic/arthroscopic method comprises the steps of inserting aneedle or a tube like instrument into the abdominal region, pelvicregion or inguinal region of the patient's body, using the needle ortube like instrument to fill the patient's body with gas, placing atleast two laparoscopic/arthroscopic trocars in the patient's body, andinserting a camera through one of the laparoscopic/arthroscopic trocarsinto the patient's body. At least one dissecting tool is insertedthrough one of said at least two laparoscopic/arthroscopic trocars,after which an area of the pelvic bone on the opposite side from saidacetabulum is dissected. Furthermore the method comprises the steps ofcreating a hole in said dissected area that passes through the pelvicbone and into the hip joint of the human patient, and providing at leastone hip joint surface to the hip joint, through the hole in the pelvicbone.

According to one embodiment, the step of inserting a needle or tube likeinstrument is performed in the abdominal wall, the inguinal area, thepelvic region or the abdominal region of the patient.

The step of dissecting an area of the pelvic bone performed in both thesurgical and the laparoscopic/arthroscopic method could be performed inthe abdominal cavity, an area between peritoneum and the pelvic bone, anarea of the pelvic bone and surrounding tissue, the pelvic area or anarea of the pelvic bone that comprises the inguinal area. Dissecting acombination of the above mentioned areas is also conceivable. It isobvious that the methods described may both be combined or alteredreaching the same goal to dissect the pelvic bone on the opposite sideof the acetabulum.

The surgical or laparoscopic/arthroscopic method could further comprisethe step of reaming the caput femur and/or the acetabulum, e.g. by meansof an expandable reamer.

According to one embodiment the artificial hip joint surface could befixated to the pelvic bone or to the caput femur after the step ofproviding said hip joint surface. The fixation could be performed bymeans of mechanical fixating members, such as screws or plates,adhesive, bone cement, or a combination thereof. When the artificial hipjoint surface has been placed in the hip joint, the surgical orlaparoscopic/arthroscopic method could further comprise the step ofclosing the hole in the pelvic bone using a bone plug, a prostheticpart, bone cement, or a combination thereof.

According to another embodiment the artificial hip joint surface isprovided by means of a mould placed in the hip joint through a hole inthe pelvic bone, the hip joint capsule or the femur bone. Saidartificial hip joint surface could comprise an artificial acetabulumsurface and/or an artificial caput femur surface. After the mould hasbeen inserted into the hip joint a fluid is injected which serves as anartificial caput femur surface after hardening. It is conceivable thatsaid mould is resorbable by the human body or made of a material adaptedto melt.

According to yet another embodiment the artificial hip joint surface isprovided by injecting a fluid into a sealed area of the hip joint. Saidartificial hip joint surface could comprise an artificial acetabulumsurface and/or an artificial caput femur surface. The sealed area issealed by means of at least one sealing member placed in said hip jointthrough a hole in the pelvic bone, the hip joint capsule or the femurbone. It is conceivable that said at lest one sealing member isresorbable by the human body or made of a material adapted to melt.

After the steps of the surgical method have been performed, theinstruments are withdrawn and the skin is closed using sutures orstaples.

The Acetabulum Surface

According to one embodiment, the step of providing an artificialacetabulum surface comprises providing an artificial acetabulum surfaceadapted to be inserted into the hip joint through a hole in the pelvicbone and to be in connection with the pelvic bone and carry the loadplaced on the caput femur from the weight of the patient by theconnection with the pelvic bone. It is conceivable that the diameter ofthe hole is larger than the largest diameter of the artificialacetabulum surface thus allowing the artificial acetabulum surface topass through the hole in its entirety, however it is also conceivablethat said hole is smaller than the largest diameter of the artificialacetabulum surface thus hindering the artificial acetabulum surface frompassing through the hole, which makes it possible for the edges of saidhole to carry the load placed on said acetabulum from the weight of thepatient.

According to one embodiment, the step of providing an artificialacetabulum surface comprises providing an artificial acetabulum surfacecomprising at least one supporting member which in turn could compriseat least one screw, adhesive, at least one plate, bone cement, a sectionof the artificial acetabulum surface or a combination of the mentionedalternatives. It is also conceivable that the supporting membercomprises a first and second part. The second part is displaceable inrelation to the first part and adapted to carry a load by the connectionwith the pelvic bone, and carries the load when displaced.

According to one embodiment, the step of providing an artificialacetabulum surface comprises providing an artificial acetabulum surfacecomprising at least two acetabulum surface parts. The at least twoartificial acetabulum surface parts are adapted to be connected to eachother after insertion in a hip joint of a human patient to form anartificial acetabulum surface. The two artificial caput femur surfaceparts could be adapted to be mechanically connected using at least oneof: at least one screw, at least one pin, at least one portion of atleast one of the parts adapted to be introduced into the other part, theparts being adapted to be sliding into the other part, form fitting,welding, adhesive, pin, wire, a ball mounted into a bowl being portionsof said parts, a male portion of one part mounted into a female portionof the other part, a key introduced into a lock being portions of saidparts, band, or other mechanical connecting members.

The artificial acetabulum being severable enables the insertion of theartificial acetabulum surface through a hole smaller than the artificialacetabulum surface which makes it possible for the edges of said hole tocarry the load placed on said acetabulum from the weight of the humanpatient.

According to one embodiment, the step of providing an artificialacetabulum surface comprises providing an artificial acetabulum surfaceadapted to have a varying largest diameter for insertion through a holein the pelvic bone from the opposite side from acetabulum, and thediameter of said artificial acetabulum surface varies when saidartificial acetabulum surface is being inserted through said hole in thepelvic bone. Since the largest diameter of the artificial acetabulumsurface is adapted to vary between being both smaller and larger thanthe hole in the pelvic bone, the hole could having a diameter smallerthan the largest diameter of the artificial acetabulum surface.

The surgical or laparoscopic/arthroscopic method could comprise the stepof inserting the artificial acetabulum surface adapted to have a varyinglargest diameter through the hole in the pelvic bone. In this embodimentit is conceivable that the artificial acetabulum surface is adapted tobe flexible in its construction, thus enabling the insertion of saidartificial acetabulum surface through a hole in the pelvic bone that issmaller than said largest diameter of the artificial acetabulum surface.The flexible part of the artificial acetabulum surface could further beadapted to expand after insertion through the hole making the largestdiameter of the artificial acetabulum surface larger than the diameterof the hole in the pelvic bone, thus hindering the artificial acetabulumsurface from passing through the hole.

Caput Femur Surface

According to one embodiment, the step of providing at least one hipjoint surface comprises the step of providing an artificial caput femursurface adapted to be in connection with said acetabulum surface. It isconceivable that the diameter of the hole is larger than the largestdiameter of the caput femur thus allowing the caput femur to passthrough the hole. However it is also conceivable that said hole issmaller than the largest diameter of the caput femur thus hindering thecaput femur from passing through the hole.

According to one embodiment, the step of providing an artificial caputfemur surface comprises providing an artificial caput femur surfacecomprising at least two caput femur surface parts adapted to beconnected to each other after insertion in a hip joint to form anartificial caput femur surface. According to one embodiment the at leasttwo artificial caput femur surface parts are inserted through a hole inthe pelvic bone from the opposite side from acetabulum, said hole havinga diameter less than the largest diameter of said artificial caput femursurface. The mechanical connection that connects the parts of theartificial caput femur surface could be created using screws, formfitting, welding, sprints, band, adhesive or some other mechanicalconnecting member.

According to one embodiment the step of providing an artificial caputfemur surface comprises providing an artificial caput femur surfaceadapted to have a varying largest diameter and having a largest diameterthat varies for insertion through a hole in the pelvic bone from theopposite side from acetabulum of said human patient. Since the largestdiameter of the artificial caput femur surface varies between being bothsmaller and larger than the hole in the pelvic bone, the hole could havea diameter smaller than the largest diameter of the artificial caputfemur surface.

According to one embodiment, the step of providing an artificial caputfemur surface comprises the step of inserting the artificial caput femursurface adapted to have a varying largest diameter through the hole inthe pelvic bone. In this embodiment it is conceivable that theartificial caput femur surface is adapted to be flexible in itsconstruction, and is flexible in its construction when being insertedthrough a hole in the pelvic bone that is smaller than said largestdiameter of the artificial caput femur surface. The flexible part of theartificial caput femur surface could further be adapted to expand, andexpands, after insertion through the hole making the largest diameter ofthe artificial caput femur surface larger than the diameter of the holein the pelvic bone, thus hindering the artificial caput femur surfacefrom passing through the hole.

According to one embodiment, the step of providing an artificial caputfemur surface comprises the step of providing at least two artificialcaput femur surface parts. These at least two artificial caput femursurface parts are adapted to be connected, and connects to each other toform an artificial caput femur surface having a greatest internalcross-sectional area. The artificial caput femur surface is hollow andhas an opening with a cross-sectional area smaller than the greatestinternal cross-sectional area of the artificial caput femur, i.e. saidartificial caput femur surface is larger than equator frustum spherical.

According to one embodiment, the step of providing an artificial caputfemur surface comprises the step of providing an artificial caput femursurface that is hollow and has a greatest internal cross-sectional areaand an opening with an area less than said greatest internalcross-sectional area of said artificial caput femur surface when mountedon the caput femur. The artificial caput femur surface further comprisesat least one slit allowing said artificial caput femur surface to bemounted on said caput femur, which requires a diameter larger that thediameter of caput femur, and an opening smaller than said greatestinternal cross-sectional area.

The surgical or laparoscopic/arthroscopic method could further comprisethe steps of, inserting at least two artificial caput femur surfaceparts into the hip joint and mounting the at least two artificial caputfemur surface parts on the hip joint to form an artificial caput femursurface. The artificial caput femur surface could be mechanicallyfixated to the caput femur by means of the mounting on the caput femur,i.e. the artificial caput femur surface can not be removed withoutdismounting the artificial caput femur surface parts.

Instruments

According to one embodiment the above mentioned step of reaming theacetabulum and/or the caput femur is performed by means of an expandablereamer after the step of inserting said expandable reamer through a holein the pelvic bone has been performed.

The expandable reamer could be adapted to be inserted through a hole inthe pelvic bone and could be adapted to be bent using one or more fixedangles, adjustable angles or parallel displaced parts or sections.

According to one embodiment the hole in said dissected area could becreated using a surgical instrument creating a through-going hole in theacetabulum area from the abdominal side of the pelvic bone of said humanpatient through repetitive or continuous movement.

The surgical instrument could be adapted to create a through-going holein the acetabulum area from the abdominal side of the pelvic bone ofsaid human patient through repetitive or continuous movement.Furthermore the surgical instrument could comprise a driving member, abone contacting organ in connection with said driving member and anoperating device adapted to operate said driving member.

According to one embodiment the step of creating a through-going hole inthe acetabulum area from the abdominal side of the pelvic bone isperformed using a surgical instrument adapted to create a through-goinghole in the pelvic bone further adapted to be bent using one or morefixed angles, adjustable angles or parallel displaced parts or sections.It is furthermore conceivable that said instrument could be adapted toream the acetabulum and/or the caput femur, e.g. by means of the bonecontacting organ being replaceable.

According to one embodiment the surgical or laparoscopic/arthroscopicmethod comprises the step of dissecting in the dissecting area. In thisembodiment it is further conceivable that said dissecting is performedusing a dissecting tool adapted to dissect an area of the pelvic bonefrom the opposite side from acetabulum.

According to one embodiment the surgical or laparoscopic/arthroscopicmethod comprises the step of placing a mould in the hip joint. In thisembodiment it is further conceivable that said mould is placed in thehip joint through at least one of, the hip joint capsule, the pelvicbone, or the femur bone using a mould placing instrument. Thisinstrument could be adapted to place a mould in the hip joint of a humanpatient, furthermore said instrument could be equipped with a fixedangle, an adjustable angle or a parallel displaced part or section forimproved reach.

According to another embodiment the above mentioned surgical orlaparoscopic/arthroscopic method comprises the step of placing at leastone sealing member in the hip joint. In this embodiment it is furtherconceivable that the sealing member is placed in the hip joint throughat least one of, the hip joint capsule, the pelvic bone, or the femurbone using an instrument adapted therefor. This instrument could beequipped with a fixed angle, an adjustable angle or a parallel displacedpart or section for improved reach.

According to some of the above mentioned embodiments, the step ofproviding an artificial caput femur or acetabulum surface comprises thesteps of providing at least two artificial acetabulum/caput femursurface parts. According to these embodiments the surgical orlaparoscopic/arthroscopic method could comprise the step of insertingthese at least two artificial acetabulum/caput femur surface parts, inwhich case a surgical instrument adapted therefor could be used. Saidinstrument could be adapted to insert the parts through at least one of,the hip joint capsule, the pelvic bone, or the femur bone. It isfurthermore conceivable that said instrument is equipped with a fixedangle, an adjustable angle or a parallel displaced part or section forimproved reach.

According to one embodiment the driving member and bone contacting organtogether from an elongated member, placing said elongated memberachieving a first supporting point for the bone contacting organ in thefemoral bone and a second supporting point in a pelvic bone.

According to one embodiment, an operating device giving force to saiddriving member from outside the body, lateral on the opposite side ofsaid hip joint outside the opposite side ilium pelvic bone outside thebody. The elongated member could be adapted to receiving force from anoperation device in the abdomen.

According to another embodiment, the elongated member is adapted toreceive said force from an operation device outside the body, lateral ofthe proximal femoral bone.

BRIEF DESCRIPTION OF DRAWINGS

The invention is now described, by way of example, with reference to theaccompanying drawings, in which:

FIG. 1 shows different locations of the incisions made in the human bodyin the surgical method,

FIG. 2 shows the hip joint in section,

FIG. 3 shows different locations where small incisions can be made inthe human body in the laparoscopic/arthroscopic method,

FIG. 4 shows the hip joint in section when a hole is created in thepelvic bone,

FIG. 5 shows the hip joint in section when a small hole is created inthe pelvic bone,

FIG. 6 shows the instrument that creates a hole in the pelvic boneaccording to a first embodiment,

FIG. 7 shows the instrument that creates a hole in the pelvic boneaccording to a first embodiment in greater detail,

FIG. 8 shows the instrument that creates a hole in the pelvic boneaccording to a second embodiment,

FIG. 9 shows the instrument that creates a hole in the pelvic boneaccording to a third embodiment,

FIG. 10 shows the bone contacting organ according to a first embodiment,

FIG. 11 shows the bone contacting organ according to a secondembodiment,

FIG. 12 shows the laparoscopic/arthroscopic method of operating the hipjoint of a human patient,

FIG. 13 shows a step of the laparoscopic/arthroscopic method in greaterdetail,

FIG. 14 shows a lateral view in section of the laparoscopic/arthroscopicmethod,

FIG. 15 shows the expandable reamer,

FIG. 16 shows the expandable reamer in its folded state,

FIG. 17 shows the expandable reamer from underneath,

FIG. 18 shows the expandable reamer being used in the surgical orlaparoscopic/arthroscopic method,

FIG. 19 shows the step of providing an artificial caput femur surface,

FIG. 20 shows the a section of the hip joint after the artificial caputfemur surface has been provided,

FIG. 21a show the insertion of artificial caput femur surface parts intothe hip joint,

FIG. 21b shows the artificial caput femur surface parts after they havebeen connected inside of the hip joint forming an artificial caput femursurface,

FIG. 21c shows how the form of the artificial caput femur surface partsenables the connection of the artificial caput femur surface parts toform an artificial caput femur surface,

FIG. 21d shows a camera being inserted into the hip joint,

FIG. 22 shows the insertion of artificial hip joint surface parts in thesurgical method,

FIG. 23 shows the artificial caput femur surface according to a firstembodiment,

FIG. 24 shows the artificial caput femur surface according to a secondembodiment,

FIG. 25a shows the artificial caput femur surface according to a thirdembodiment,

FIG. 25b shows the function of the artificial caput femur surfaceaccording to a third embodiment,

FIG. 25c shows the artificial caput femur surface according to a thirdembodiment, in its folded state,

FIG. 25d shows the artificial caput femur surface according to a thirdembodiment in perspective,

FIG. 25e shows the connecting function of the artificial caput femursurface according to a third embodiment,

FIG. 26a shows the artificial caput femur surface according to a fourthembodiment,

FIG. 26b shows the artificial caput femur surface according to thefourth embodiment in its folded state,

FIG. 27a shows the artificial caput femur surface according to a fifthembodiment,

FIG. 27b shows the artificial caput femur surface according to the fifthembodiment in greater detail,

FIG. 27c shows the artificial caput femur surface according to the fifthembodiment when assembled,

FIG. 28a shows the artificial caput femur surface according to a sixthembodiment,

FIG. 28b shows the artificial caput femur surface according to a sixthembodiment when fixated to the caput femur,

FIG. 28c shows an artificial caput femur surface being larger thanequator frustum spherical,

FIG. 29a shows the artificial caput femur surface according to a seventhembodiment,

FIG. 29b shows the artificial caput femur surface according to theseventh embodiment when assembled,

FIG. 29c shows the artificial caput femur surface according to theseventh embodiment with the connecting members enlarged,

FIG. 30 shows an artificial acetabulum surface when being inserted intoa hip joint,

FIG. 31 shows an artificial acetabulum surface according to a firstembodiment,

FIG. 32a shows an artificial acetabulum surface according to a secondembodiment,

FIG. 32b shows an artificial acetabulum surface according to the secondembodiment in greater detail,

FIG. 32c shows the artificial acetabulum surface when assembled,

FIG. 33a shows an artificial acetabulum surface according to a thirdembodiment,

FIG. 33b shows an artificial acetabulum surface according to the thirdembodiment when assembled,

FIG. 33c shows the connection function of the artificial acetabulumsurface according to the third embodiment,

FIG. 34a shows an artificial acetabulum surface according to a fourthembodiment,

FIG. 34b shows the function of the artificial acetabulum surfaceaccording to the fourth embodiment,

FIG. 34c shows an artificial acetabulum surface according to a fourthembodiment in its folded state,

FIG. 34d shows the connection function of the artificial acetabulumsurface according to the fourth embodiment,

FIG. 35a shows an artificial acetabulum surface according to a fifthembodiment,

FIG. 35b shows an artificial acetabulum surface according to the fifthembodiment in its folded state,

FIG. 36a shows an instrument for inserting parts into a hip jointaccording to a first embodiment,

FIG. 36b shows an instrument for inserting parts into a hip jointaccording to a second embodiment,

FIG. 36c shows an instrument for inserting parts into a hip jointaccording to a third embodiment,

FIG. 37 shows a hip joint in section after an artificial caput femursurface and an artificial acetabulum surface have been provided,

FIG. 38 shows a hip joint in section when a mould is being inserted,

FIG. 39a shows the creation of a hole in the femur bone,

FIG. 39b shows an instrument able to introduce objects into a hip jointthrough the femur bone,

FIG. 39c shows the placing of a mould inside of the hip joint using aninstrument that operates through the femur bone,

FIG. 39d shows the hip joint in section after the placing of a mouldinside of the hip joint using an instrument that operates through thefemur bone,

FIG. 40 shows the insertion of a first sealing member into a hip joint,

FIG. 41 shows the insertion of a second sealing member,

FIG. 42a shows the creation of a hole in the femur bone,

FIG. 42b shows an instrument able to introduce objects into a hip jointthrough the femur bone,

FIG. 42c shows the placing of a sealing member inside of the hip jointusing an instrument that operates through the femur bone,

FIG. 43a shows an instrument for insertion of a mould or a sealingmember into a hip joint,

FIG. 43b shows the instrument for insertion of a mould or a sealingmember into a hip joint in section,

FIG. 43c shows the instrument for insertion of a mould or a sealingmember into a hip joint according to a second embodiment,

FIG. 44 shows the insertion of fluid into an area of the hip joint,

FIG. 45 shows the filling of a sealed area inside of the hip joint usingan instrument that operates through the pelvic bone,

FIG. 46 shows the filling of a mould inside of the hip joint using aninstrument that operates through the femur bone,

FIG. 47 shows the filling of a sealed area inside of the hip joint usingan instrument that operates through the femur bone,

FIG. 48 shows a hip joint in section after a sealed area in the hipjoint has been filled with a fluid,

FIG. 49 shows the closing of a hole in the hip joint using a bone plug,

FIG. 50 shows the fixation of a bone plug in the pelvic bone,

FIG. 51 shows a part for closing a hole in the pelvic bone havingdisplaceable supporting members,

FIG. 52a shows a prosthetic part being used to close a hole in thepelvic bone,

FIG. 52b shows how sections of a prosthetic part is used as supportagainst the edges of the hole in the pelvic bone,

FIG. 52c shows the insertion of a prosthetic part in the hole in thepelvic bone,

FIG. 53a shows how screws are being used to fixate a bone plug or aprosthetic part in the hole in the pelvic bone of a human patient,

FIG. 53b shows how a supporting plate is being used to fixate a boneplug or a prosthetic part in the hole in the pelvic bone of a humanpatient,

FIG. 53c shows two bone plugs or prosthetic parts being fixated using asupporting plate,

FIG. 53d shows a section of the hip joint after two holes in the pelvicbone have been filled with a fluid,

FIG. 54a shows an injecting member adapted to inject a fluid into anarea of the hip joint,

FIG. 54b shows an injecting member adapted to inject a fluid into anarea of the hip joint when injecting a fluid,

FIG. 55 shows an injecting member in further detail,

FIG. 56a shows the step of suturing or stapling in the surgical method,

FIG. 56b shows the step of suturing or stapling in thelaparoscopic/arthroscopic method,

DEFINITIONS

Functional position size and full functional size is the size of theartificial hip joint surface when it performs its function of working asa hip joint surface inside of the hip joint.

Frustum spherical is a geometric shape wherein a section of a sphere hasbeen removed from a full sphere along a cross-sectional area of thesphere. Larger than equator frustum spherical aims to illustrate thatthe section removed from the sphere is smaller than the remainder sothat the surface of the sphere still covers more than half of a fullsphere and thus passes beyond the equator of said full sphere. Anillustration of the larger than equator frustum spherical artificialcaput femur surface is given in FIG. 28 c.

The largest diameter of caput femur is the largest diameter of thesphere shaped caput femur that could be created with a radiussubstantially perpendicular to the collum femur bone.

A cross-sectional distance is the distance between two or more elementslocated on a common three dimensional geometrical structure. Accordingto one embodiment a cross sectional distance is the distance between twoelements on an artificial caput femur surface, wherein said two elementsproduces a spherical shape having said cross-section.

Functional hip movements are to be understood as movements of the hipthat at least partly correspond to the natural movements of the hip. Onsome occasions the natural movements of the hip joint might be somewhatlimited or altered after hip joint surgery, which makes the functionalhip movements of a hip joint with artificial surfaces somewhat differentthan the functional hip movements of a natural hip joint.

The functional position of an implantable medical device or prosthesisis the position in which the hip joint can perform functional hipmovements. The final position is to be understood as a functionalposition in which the medical device needs no further position change.

Biocompatible material is to be understood as being a material with lowlevel of immune response. Biocompatible materials are sometimes alsoreferred to as biomaterials. Analogous is biocompatible metals abiocompatible metal with low immune response such as titanium ortantalum. The biocompatible metal could also be a biocompatible alloycomprising at least one biocompatible metal.

Form fitting is to be understood as an element having a part or sectionwhich is adapted to enable a mechanical connection of said element to atleast one other element using said part or section. Form fittedstructure is a structure of an element which enables form fitting.

DETAILED DESCRIPTION

In the following a detailed description of embodiments of the presentinvention will be given. In the drawing figures, like reference numeralsdesignate identical or corresponding elements throughout the severalfigures. It will be appreciated that these figures are for illustrationonly and are not in any way restricting the scope of the invention.Thus, any references to direction, such as “up” or “down”, are onlyreferring to the directions shown in the figures. Also, any dimensionsetc. shown in the figures are for illustration purposes.

The medical device according to any of the embodiments could comprise atleast one material selected from a group consisting of:polytetrafluoroethylene (PTFE), perfluoroalkoxy (PFA) and fluorinatedethylene propylene (FEP). It is furthermore conceivable that thematerial comprises a metal alloy, such as cobalt-chromium-molybdenum ortitanium or stainless steel, or polyethylene, such as cross-linkedpolyethylene or gas sterilized polyethylene. The use of ceramic materialis also conceivable, in the contacting surfaces or the entire medicaldevice such as zirconium or zirconium dioxide ceramics or aluminaceramics. The part of the medical device in contact with human bone forfixation of the medical device to human bone could comprise a poorhousestructure which could be a porous micro or nano-structure adapted topromote the growth-in of human bone in the medical device for fixatingthe medical device. The porous structure could be achieved by applying ahydroxy-apatite (HA) coating, or a rough open-pored titanium coating,which could be produced by air plasma spraying, a combination comprisinga rough open-pored titanium coating and a HA top layer is alsoconceivable. The contacting parts could be made of a self lubricatedmaterial such as a waxy polymer, such as PTFE, PFA, FEP, PE and UHMWPE,or a powder metallurgy material which could be infused with a lubricant,which preferably is a biocompatible lubricant such as a Hyaluronic acidderivate. It is also conceivable that the material of contacting partsor surfaces of the medical device herein is adapted to be constantly orintermittently lubricated. According to some embodiments the parts orportions of the medical device could comprise a combination of metalmaterials and/or carbon fibers and/or boron, a combination of metal andplastic materials, a combination of metal and carbon based material, acombination of carbon and plastic based material, a combination offlexible and stiff materials, a combination of elastic and less elasticmaterials, Corian or acrylic polymers.

FIG. 1 shows a frontal view of the body of a human patient. A surgicalmethod of operating the hip joint from the opposite side fromacetabulum, is according to a first embodiment performed starting withan incision 1 in the abdominal wall of the human patient. The incision 1passes through the rectus abdominis and peritoneum in to the abdomen ofthe human patent. In a second preferred embodiment the incision 2 isconducted through the abdominal wall, preferably rectus abdominis and into the pelvic area, below peritoneum. According to a third embodimentthe incision 3 is performed just between Illium and the surroundingtissue, an incision 3 which could enable the pelvic bone to be dissectedwith very little penetration of fascia and muscular tissue. According toa fourth embodiment the incision 4 is made in the inguinal channel. Inall of the four embodiments the tissue surrounding the pelvic bone 9 inthe area opposite to acetabulum is removed or penetrated which enablesthe surgeon to reach the pelvic bone 9.

FIG. 2 shows the hip joint of a human patient in a lateral view. The hipjoint comprises a caput femur 5 placed at the very top of collum femur 6which is the top part of the femur bone 7. The caput femur is inconnection with the acetabulum 8 which is a bowl shaped part of thepelvic bone 9. Both the caput femur surface 10 and the acetabulumsurface 11 is covered with articular cartilage 13 which acts as acushion in the hip joint. In patients with hip joint osteoarthritis,this articular cartilage 13 is abnormally worn down due to a low gradeinflammation. The hip joint is surrounded by the hip joint capsule 12which provides support for the joint and hinders luxation. Afterconventional hip joint surgery, penetrating the hip joint capsule 12,the capsule 12 is dramatically weakened due to the limited healingpossibilities of its ligament tissue. By performing hip joint surgerywithout damaging the hip joint capsule 12 the patient can fully recoverand place equal amount of strain on an artificial joint as is possibleon a natural one.

FIG. 3 shows a frontal view of the body of a human patient. Alaparoscopic/arthroscopic method of operating the hip joint, from theopposite side from acetabulum, is according to a first embodimentperformed starting with making small incisions 14 in the abdominal wallof the human patient. The small incisions enable the surgeon to insertlaparoscopic/arthroscopic trocars into the abdomen of the human patient.According to the first embodiment the incisions 14 passes through therectus abdominis and peritoneum in to the abdomen of the human patent.According to a second preferred embodiment the small incisions 15 isconducted through the rectus abdominis and in to the pelvic area, belowperitoneum.

According to a third embodiment the small incisions 16 is performed justbetween Illium and the surrounding tissue, an incision 16 which couldenable the pelvic bone to be dissected with very little penetration offascia and muscular tissue. According to a fourth embodiment theincision 17 is made in the inguinal channel. In all of the fourembodiments the tissue surrounding the pelvic bone 9 in the areaopposite to acetabulum 8 is removed or penetrated which enables thesurgeon to reach the pelvic bone 9.

After dissecting the pelvic bone 9 a hole 18 is created in the bone 9,shown in FIG. 4. The hole 18 passes through the pelvic bone from theopposite side from acetabulum 8 and into the hip joint 19. According toa first embodiment the hole 18 is large which allows a prosthesis topass through said hole 18 in its full functional size. According to asecond embodiment the hole 20 created in the surgical orlaparoscopic/arthroscopic method is much smaller as shown in FIG. 5allowing the surgical instrument creating the hole to be smaller, andthus the incision and dissection performed in the human body.

FIG. 6 shows a first embodiment of said surgical instrument creating thehole 18, 20 in the pelvic bone 9. The surgical instrument comprises adriving member 21 a, b. The driving member 21 a,b could be a shaft, arod, a belt, a chain or any other element suitable for transferringforce or torque. The surgical instrument also comprises a bonecontacting organ 22 which is adapted to create the hole 18, 20 in thepelvic bone 9. The bone contacting organ 22 could have a sawing,drilling or milling effect using sharp objects; it is furthermoreconceivable that said bone contacting organ 22 creates a hole usingwater, abrasive fluids, laser or radiation. The surgical instrument alsocomprises an operating device 23 a adapted to operate the driving member21 a,b. The operating device could comprise an electrical, mechanical,pneumatic or magnetic motor and it could be adapted to create arotating, oscillating, vibrating or repetitive movement. According toone embodiment the operating device 23 b could be placed in directconnection with the bone contacting organ 22 shown in FIG. 7 in whichcase the operating device 23 b also serves as driving member. In thisconstruction a handle portion 24 could be attached to the surgicalinstrument facilitating the surgeons handling of said surgicalinstrument. To improve the reach of the surgical instrument the handleportion 24 could be attached perpendicular to the hole-creatingdirection 25 of the surgical instrument, it is furthermore conceivablethat the handle portion 24 is bent by means of a parallel displaced partor section, a fixed angle, an adjustable angle or a flexible part orsection.

According to one embodiment of FIG. 6 the surgical instrument furthercomprises a parallel displaced part or section 26. The paralleldisplaced part or section 26 improves the reach of the medical deviceand enables the creation of a hole 18 in the pelvic bone 9 from theopposite side from acetabulum 8. According to one embodiment shown inFIG. 6 the parallel displaced part or section 26 has a telescopicfunction by means of the parallel displaced part or section 26 beingdivided in to a first and second part 27 a,b, wherein the second part 27b can slide in and out of the first part 27 a.

FIG. 8 shows the surgical instrument according to a second embodimentwherein said surgical instrument comprises a driving member 28 a,b,cwith two angle adjusting members 29 a,b. The angle adjusting members 29a,b could be adjustable for varying the angle of said driving member 28a,b,c or fixed in an angle suitable for creating a hole in the pelvicbone 9 from the opposite side from acetabulum 8. In another embodiment(not shown) the part of the driving member 28 c in connection with thebone contacting organ 22 could be very short enabling the surgicalinstrument to operate very close to the pelvic bone 9 when creating ahole 18 in said pelvic bone 9.

FIG. 9 shows the surgical instrument according to a third embodimentwherein the driving member 30 is flexible, enabling said driving member30 to be very precisely adjusted to create a hole 18 in the pelvic bone9 of the patient. The stiffness of said driving member 30 could rangefrom completely flexible to completely stiff to fit the surroundings ofthe particular operation.

FIG. 10 shows the bone contacting organ according to a first embodimentwherein the bone contacting organ 22 a is adapted to crate a bone plug31. The bone plug 31 could be adapted to be replaced into said hole 18after the steps of the surgical or laparoscopic/arthroscopic method havebeen performed in the hip joint.

FIG. 11 shows the bone contacting organ according to a second embodimentwherein the bone contacting organ 22 b is adapted to create small piecesof bone 32 when creating said hole 18 in the pelvic bone 9. The smallpieces of bone could be transported from the area and out of the bodyusing vacuum power or a hydraulic transport system.

FIG. 12 shows a frontal view of the body of a human patient,illustrating the laparoscopic/arthroscopic method of operating the hipjoint from the opposite side from acetabulum 8. The hip joint comprisingthe acetabulum 8 and the caput femur 5. The small incisions 14 in theabdominal wall of the human patient allows the insertion oflaparoscopic/arthroscopic trocars 33 a,b,c into the body of thepatients. Whereafter one or more camera 34, a surgical instrumentadapted to create a hole in the pelvic bone 35, or instruments 36 forintroducing, placing, connecting, attaching, creating or fillingprosthesis or prosthetic parts, can be inserted into said body throughsaid laparoscopic/arthroscopic trocars 33 a,b,c.

FIG. 13 shows a close-up of the insertion 37 of prosthetic parts 38 intothe patients body through said laparoscopic/arthroscopic trocars 33a,b,c.

FIG. 14 shows a lateral view of the body of a human patient, with thehip joint shown in section. The hip joint comprises a caput femur 5placed at the very top of collum femur 6 which is the top part of thefemur bone 7. The caput femur 5 is in connection with the acetabulum 8which is a bowl shaped part of the pelvic bone 9.Laparoscopic/arthroscopic trocars 33 a,b,c is being used to reach thehip joint 39 with one or more camera 34, a surgical instrument 35adapted to create a hole in the pelvic bone 9, or instruments 36 forintroducing, placing, connecting, attaching, creating or fillingprosthesis or prosthetic parts.

The surgical and laparoscopic/arthroscopic methods shown in FIG. 1, 3,12, 13, 14 further comprises the step of reaming the acetabulum 8 or thecaput femur 5. According to a first embodiment the reaming of theacetabulum 8 or the caput femur 5 is performed using an expandablereamer shown in FIG. 15-17. The expandable reamer comprises at least onereaming blade 40 which comprises a reaming surface 41 a,b. Saidexpandable reamer could be adapted to ream the acetabulum 8, the caputfemur 5 or both. In the embodiment where said expandable reamer isadapted to ream the acetabulum 8 said reaming surface 41 a is located onthe exterior part of the at least one reaming blade 40, whereas in theembodiment when said expandable reamer is adapted to ream the caputfemur 5, said reaming surface 41 b is located on the interior part ofthe at least one reaming blade 40. According to a second embodiment saidexpandable reamer is adapted to ream both the acetabulum and the caputfemur, in which case the reamer has reaming surfaces 41 a,b both on theexterior and the interior part of the at least one reaming blade 40.

FIG. 16 shows the expandable reamer according to a third embodiment,wherein the reaming blades 40 can be folded towards a center of thesemi-sphere that the expandable reamer produces in its expanded state,shown in FIG. 15. The folding of the reaming blades 40 enables theexpandable reamer to be introduced into a hip joint through a holesmaller than the area possible to ream using said expandable reamer.

FIG. 17 shows the interior said of the expandable reamer with thereaming blades 40. In the embodiment when the expandable reamer isadapted to ream the caput femur said interior side of the at least onereaming blade 40 comprises a reaming surface 41 b.

FIG. 18. shows the expandable reamer according to any of the embodimentswhen reaming said acetabulum 8 and/or said caput femur 5. The reamer canbe adapted to be operated manually or by means of a rotating, vibratingor oscillating operating device.

According the one embodiment the bone contacting organ 22 of thesurgical instrument shown in FIG. 6-11 can be replace with theexpandable reamer shown in FIG. 15-17, and in which case the expandablereamer can be powered using the operating device 23 a,b used in saidsurgical instrument.

After the preparation of the hip joint surfaces the method step ofinserting or creating new surfaces is performed.

FIG. 19 shows the hip joint in section with the caput femur 5 placed atthe very top of collum femur 6 which is the top part of the femur bone7. The caput femur is in connection with the acetabulum 8 which is abowl shaped part of the pelvic bone 9. According to a first embodimentthe hole 18 created in the pelvic bone 9 from the opposite side fromacetabulum 8, is larger than said artificial caput femur surface 45,enabling the insertion of said artificial caput femur surface 43 in itsfull functional size. Said insertion of said artificial caput femursurface 43 could be performed as a step of the surgical method, as wellas a step of the laparoscopic/arthroscopic method. After the insertion,the artificial caput femur surface 43 is attached to the caput femur 5,according to the embodiment shown in FIG. 19-20 the attaching isperformed by means of a mechanical attachment 44 comprising a shaft orscrew penetrating the cortex. It is however also conceivable that themechanical attachment 44 is assisted by bone cement or adhesive placedbetween caput femur 5 and the artificial caput femur surface 43, or inconnection with said shaft or screw 44. Alternative ways of attachingthe artificial caput femur surface 43 includes: form fitting, welding,sprints, band or some other mechanical connecting member.

FIG. 20 shows the hip joint in section with the artificial caput femursurface 43 attached to the caput femur 5.

FIG. 21a shows the hip joint in section according to a second embodimentin which the hole 18 in the pelvic bone 9 is smaller than the artificialcaput femur surface 45 in its full functional size. According to thisembodiment the artificial caput femur surface 45 is introduced into saidhip joint through the hole 18 in the pelvic bone 9 form the oppositeside from acetabulum 8. The artificial caput femur surface parts 46 areconnected to each other after insertion into said hip joint to form theartificial caput femur surface 45.

FIG. 21b shows the hip joint in section when the artificial caput femursurface parts 46 are connected to each other using form fitting 47,however it is conceivable that the form fitting is assisted or replacedwith adhesive or bone cement. After the artificial caput femur surfaceparts 46 have been introduced and connected in the hip joint, they aremechanically fixated to the caput femur 5, the mechanical fixation couldbe done by means of screws, form fitting, welding, sprints, band,adhesive or some other mechanical attachment member.

FIG. 21c shows the artificial caput femur surface parts 46 with theparts supplying the form fitting 47.

FIG. 21d shows the hip joint in section wherein a second hole 18 b inthe pelvic bone 9 enables the surgeon to place a camera 34 into the hipjoint, preferably used in the laparoscopic/arthroscopic method.

FIG. 22 shows the artificial hip joint surface parts 48 being insertedthrough an incision according to the surgical method. According to afirst embodiment the artificial hip joint surface parts 48 areartificial caput femur surface parts 46, adapted to be connected to eachother after the insertion to form an artificial caput femur surface 45.The same insertion can be performed in the laparoscopic/arthroscopicmethod, shown in FIG. 13.

FIG. 23 shows the artificial caput femur surface 45 according to a firstembodiment also shown in FIG. 19-20. The shaft or screw placed in themiddle of the artificial caput femur surface 45 serves as a mechanicalattachment 44 penetrating the cortex of the caput femur 5 and fixatingthe artificial caput femur surface 45 to the caput femur 5.

FIG. 24 shows a second embodiment of the artificial caput femur surface45. The second embodiment comprises at least one slit 49 enabling theconstruction of the artificial caput femur surface 45 to be flexible,thus enabling the largest diameter 51 to vary for insertion of saidartificial caput femur surface 45 through a hole in the pelvic bone 9smaller than the full functional size of said artificial caput femursurface 45. According to this embodiment the artificial caput femursurface 45 further comprises artificial caput femur surface arms 50located on the sides of said at least one slit 49. The caput femursurface arms 50 can be made of a flexible material enabling theinsertion through a hole 18 in the pelvic bone 9 smaller than thelargest diameter 51 of said artificial caput femur surface 45 when inits full functional size.

According to one embodiment the artificial caput femur surface 45 couldbe adapted to pass beyond the maximum diameter of the caput femur 5.This enables a mechanical fixation using the form of said artificialcaput femur surface 45. In the embodiment where the artificial caputfemur surface 45 travels beyond the maximum diameter of the caput femur5 the construction can be made flexible so that the size of theartificial caput femur surface 45 can vary to become smaller forinsertion through a hole 18 in the pelvic bone smaller than the fullfunctional size of the artificial caput femur surface 45, and have anopening adapter to travel over the caput femur 5 that can be larger thatthe same opening is in the full functional size of the artificial caputfemur surface 45 enabling the artificial caput femur surface 45 to atleast partly cover an area beyond the maximum diameter of caput femur 5from the direction of the acetabulum 8. According to a second embodimentthe artificial caput femur surface 45 comprises two or more artificialcaput femur surface arms 50 which have a cross sectional distance 52between each other. This cross sectional distance 52 is according to oneembodiment shorter than the maximum diameter of the caput femur 5enabling the mechanical fixation of the artificial caput femur surface45 by means of said artificial caput femur surface arms 50.

FIG. 25 a,b,c,d,e shows the artificial caput femur surface 45 accordingto a fourth embodiment, in which said artificial caput femur surface 45comprises a first 53 a and a second 53 b section, as shown in FIG. 25b .The first and second sections are displaceable in relation to eachother. According to a first embodiment said first section 53 a can berotated in relation to said second section 53 b so that said secondsection 53 b travels underneath said first section 53 a to create adisplaced artificial caput femur surface 54, as shown in FIG. 25c ,which is possible to insert into a hip joint of a human patient througha hole 18 being oval, or at least having an area smaller than the crosssectional area of the artificial caput femur surface 45 when in its fullfunctional size 45, as shown in FIG. 25a . According to this embodimentthe two sections are connected to each other when the artificial caputfemur surface 45 is returned to its full functional size using amechanical form fitting 55, as shown in FIG. 25e . However it is alsoconceivable that said connection is assisted or replaced with screws,welding, sprints, band, adhesive or some other mechanical connectingmember.

FIG. 26 shows a fourth embodiment of an artificial caput femur surface45 comprising four slits. The artificial caput femur surface 45 isflexible in its construction allowing the four artificial caput femurarms 50 to be folded towards the center axis of the artificial caputfemur surface 45 thus allowing the artificial caput femur surface 45 tobe inserted into a hip joint through a hole smaller than the fullfunctional size of the artificial caput femur surface 45.

The artificial caput femur surface 45 according to this embodiment canbe constructed to go beyond the maximum diameter of the caput femur 5,in which case the construction with the slits 49 allows the artificialcaput femur surface 45 to change to both a smaller and a larger sizethan said full functional size.

FIG. 26b shows the artificial caput femur surface 45 in section whensaid artificial caput femur surface arms 50 are folded for insertionthrough a hole 18 with an area smaller than the largest area of theartificial caput femur surface 45 when in its full functional size.

FIG. 27a shows fifth embodiment of the artificial caput femur surface 45having multiple artificial caput femur surface parts 46. Said multipleartificial caput femur surface parts 46 are adapted to be connected toan interconnecting artificial caput femur surface part 56 afterinsertion into a hip joint. The interconnecting artificial caput femursurface part 56 comprises self locking connecting members 57, shown inFIG. 27b , that fits with corresponding self locking members 58 of theartificial caput femur surface parts 46. The artificial caput femursurface parts 46 creates an artificial caput femur surface 45 whenconnected to each other, shown in FIG. 27c . The self locking members57,58 can be assisted or replaced with screws, welding, sprints, band,adhesive or some other mechanical connecting member. The artificialcaput femur surface 45 according to this embodiment can further beadapted to go beyond the maximum diameter of the caput femur 5.

FIG. 28a shows a sixth embodiment the artificial caput femur surface 45adapted to pass beyond the maximum diameter of the caput femur 5. Thisenables a mechanical fixation using the form of said artificial caputfemur surface 45. In this embodiment the artificial caput femur surface45 comprises at lest two slits 49 adapted to make said artificial caputfemur surface 45 flexible for travelling over and beyond the maximumdiameter of the caput femur 5. The construction could further be madeflexible so that the size of the artificial caput femur surface 45 canvary to become smaller for insertion through a hole 18 in the pelvicbone 9 smaller than the full functional size of the artificial caputfemur surface 45. It is also conceivable that the artificial caput femursurface 45 comprises two or more artificial caput femur surface arms 50which have a cross sectional distance 52 between each other. This crosssectional distance 52 is according to one embodiment shorter than themaximum diameter of the caput femur 5 enabling the mechanical fixationof the artificial caput femur surface 45 by means of said artificialcaput femur surface arms 50. For further fixation a band, cord or wire59 can be placed around the artificial caput femur surface 45 beyond themaximum diameter of the caput femur 5. The band, cord or wire can bemechanically connected using a self locking member 60 for forming aring-shaped element able to assist in the fixation of the artificialcaput femur surface 45 to the caput femur 5.

FIG. 28b shows the artificial caput femur surface 45 when fixated to thecaput femur with the supporting band, cord or wire placed around theartificial caput femur surface 45 beyond the maximum diameter of thecaput femur 5.

FIG. 28c shows the artificial caput femur surface 45 in section having agreatest cross-sectional distance 52 adapted to travel over and beyondthe maximum diameter of the caput femur 5. The maximum diameter of thecaput femur 5 being positioned at a corresponding largest crosssectional distance 61 of the artificial caput femur surface A seconddistance 62 is the distance that the artificial caput femur surface 45travels beyond the maximum diameter of the caput femur 5. Said distance62 being part of the mechanical fixation of the artificial caput femursurface 45 to the caput femur 5.

FIG. 29a shows a seventh embodiment of the artificial caput femursurface 45 comprising multiple ring-shaped artificial caput femursurface parts 63. Said multiple ring-shaped artificial caput femursurface parts 63 are adapted to be connected to each other to form anartificial caput femur surface 45. According to one embodiment saidartificial caput femur surface parts 63 are adapted to be connected toeach other using mechanical connecting members 64 a,b. 64 a shows how anindividual ring-shaped artificial caput femur surface part 63 can beconnected to itself to form a continuous ring shape. 64 b shows how anindividual ring-shaped artificial caput femur surface part 63 connectsto other ring-shaped artificial caput femur surface parts 63 to form anartificial caput femur surface 45. The artificial caput femur surface 45according to this embodiment can further be adapted to go beyond themaximum diameter of the caput femur 5.

After the step of providing an artificial caput femur surface thesurgical and laparoscopic/arthroscopic methods could further comprisesthe step of providing an artificial acetabulum surface.

According to a first embodiment the artificial acetabulum surface 65 isprovided through a hole 18 in the pelvic bone 9 from the opposite sidefrom acetabulum 8. FIG. 30 shows an artificial acetabulum surface 65 inits full functional size as it is being inserted through a hole 18 inthe pelvic bone 9.

FIG. 31 shows an artificial acetabulum surface 65 according to a secondembodiment in which the artificial acetabulum surface 65 comprises atleast one slit 66 enabling the artificial acetabulum surface 65 to varyin size for insertion through a hole 18 in the pelvic bone 9 smallerthan the full functional size of the artificial caput femur surface 45.The slits 66 are placed between one or more artificial caput femursurface arms 67 which are flexible by means of the material or by meansof a joint affecting said artificial caput femur surface arms 67.

FIG. 32 a,b,c shows an artificial acetabulum surface 65 according to asecond embodiment in which the artificial acetabulum surface 65comprises multiple artificial acetabulum surface parts 68. Said multipleartificial acetabulum surface parts 68 are adapted to be connected to aninterconnecting artificial acetabulum surface part 69 after insertioninto a hip joint. The interconnecting artificial caput femur surfacepart 69 comprises self locking connecting members 70 a, shown in FIG.32b , that fits with corresponding self locking members 70 b of theartificial acetabulum surface parts 68. The artificial acetabulumsurface parts 68 create an artificial acetabulum surface 65 whenconnected to each other, shown in FIG. 32c . The self locking members 70a,b can be assisted or replaced with screws, welding, sprints, band,adhesive or some other mechanical connecting member.

FIG. 33 a,b,c shows an artificial acetabulum surface 65 according to athird embodiment in which the artificial acetabulum surface 65 comprisesmultiple ring-shaped artificial acetabulum surface parts 71. Saidmultiple ring-shaped artificial acetabulum surface parts 71 are adaptedto be connected to each other to form an artificial acetabulum surface65 after insertion in a hip joint. According to one embodiment saidartificial acetabulum surface parts 71 are adapted to be connected toeach other using mechanical connecting members 72 a,b.

FIG. 33c shows how an individual ring-shaped artificial acetabulumsurface part 72 a can be connected to itself using the mechanicalconnecting member 70 a to form a continuous ring shape. Further 33 cshows how an individual ring-shaped artificial acetabulum surface part71 connects to other ring-shaped artificial acetabulum surface parts 63using the mechanical connecting member 72 b to form an artificialacetabulum surface 65.

FIG. 34 a,b,c,d shows an artificial acetabulum surface 65 according to afourth embodiment in which the artificial acetabulum surface 65comprises a first 73 a and a second 73 b section, shown in FIG. 34b .The first and second sections are displaceable in relation to eachother. According to a first embodiment said first section 73 a can berotated in relation to said second section 73 b so that said secondsection 73 b travels underneath said first section 73 a to create adisplaced artificial acetabulum surface 74, as shown in FIG. 34c , whichis possible to insert into a hip joint of a human patient through a holebeing oval, or at least having an area smaller than the cross sectionalarea of the artificial acetabulum surface 65 when in its full functionalsize 65. According to this embodiment the two sections 73 a,b areconnected to each other when the artificial acetabulum surface isreturned to its full functional size using a mechanical form fitting 75,as shown in FIG. 34d . However it is also conceivable that saidconnection is assisted or replaced with screws, welding, sprints, band,adhesive or some other mechanical connecting member.

FIG. 35a shows an artificial acetabulum surface 65 according to a fifthembodiment in which the artificial acetabulum surface 65 comprises fourslits 66. The artificial acetabulum surface 65 is flexible in itsconstruction allowing the four artificial acetabulum arms 67 to befolded towards the center axis of the artificial acetabulum surface 65thus allowing the artificial acetabulum surface to be inserted into ahip joint through a hole smaller than the full functional size of theartificial acetabulum surface 65.

FIG. 35b shows the artificial acetabulum surface 65 according to thefifth embodiment in its folded state.

FIG. 36a shows a surgical instrument adapted to insert a prosthesis,prosthetic parts or parts needed to create or provide a hip jointsurface, according to a first embodiment. The surgical instrumentcomprises a gripping portion 76 and a handling portion 77. According tothe embodiments shown in FIG. 36 a,b,c the instrument further comprisesa rotation element 78 that enables the gripping part 76 to rotate inrelation to the handling part 77, however it is equally conceivable thatthe surgical instrument lacks this rotation element 78.

FIG. 36b shows the surgical instrument adapted to insert a prosthesis,prosthetic parts or parts needed to create or provide a hip jointsurface, according to a second embodiment. According to this embodimentthe surgical instrument further comprises a parallel displaced section79, which increases the reach of the instrument and facilitates thereaching of the hip joint through a hole in the pelvic bone from theopposite side from acetabulum.

FIG. 36c shows the surgical instrument adapted to insert a prosthesis,prosthetic parts or parts needed to create or provide a hip jointsurface, according to a third embodiment. According to this embodimentthe surgical instrument further comprises two angle adjusting members 80a,b. The angle adjusting members could be adjustable for varying theangle of said gripping part 76 in relation to the handling portion 77,or fixed in an angle suitable for creating operating in a hip jointthrough a hole in the pelvic bone from the opposite side from acetabulum8.

FIG. 37 shows the hip joint in section after the artificial caput femursurface 45, and the artificial acetabulum surface 65 have been provided.

A different approach to the step of providing an artificial hip jointsurface will now be described. This approach comprises the steps ofcasting an artificial hip joint surface inside of the hip joint. Thesesteps can be performed by means of a mould, or without.

FIG. 38 shows the step of placing a mould 81 inside of the hip joint ofa human patient through a hole 18 in the pelvic bone 9. The step ofplacing said mould 81 can be performed in the surgical, or in thelaparoscopic/arthroscopic method.

FIG. 39 a,b,c,d shows an alternative approach to placing said mould 81in the hip joint of a human patient. Said alternative approach comprisesthe steps of creating a hole 82 in the femur bone 7 following a lengthaxis of the collum femur 6, said hole starting from the lateral side ofthe thigh, penetrating the cortex of the femur bone 7 and eventuallyreaching the cortex of the caput femur 5 from the inside thereof,penetrating said cortex and entering into the hip joint. After thecreation of the hole 82 in the femur bone 7 the mould 81 is insertedinto the hip joint through the hole 82 using a surgical instrument 83adapted therefor, shown in FIG. 39 b.

FIG. 39c shows the mould 82 when being inserted into the hip joint usingthe surgical instrument 83 adapted therefor.

FIG. 39d shows the mould 82 after insertion into the hip joint, thesurgical instrument used to place said mould 82 in the hip joint isrefracted after the insertion is completed.

It is also conceivable that the hip joint surface is provided by castingthe hip joint surface inside of the hip joint without the use of amould.

FIG. 40 shows the hip joint in section wherein a first sealing member 84is inserted through a hole 18 in the pelvic bone 9 using an instrumentadapted therefor 85. The step of placing said first sealing member 84can be performed in the surgical, or in the laparoscopic/arthroscopicmethod.

FIG. 41 shows the hip joint in section wherein a second sealing member86 is inserted through the surgical or laparoscopic/arthroscopic method.The first 84 and second 86 sealing members creates a sealed space 87between the acetabulum 8 and the caput femur 5 adapted to be used as amould for providing an artificial acetabulum 65 and/or a caput femursurface 45.

FIG. 42 a,b,c shows an alternative approach to placing said firstsealing member 84 in the hip joint of a human patient. Said alternativeapproach comprises the steps of creating a hole 82 in the femur bone 7following a length axis of the collum femur 6, as shown in FIG. 44a ,said hole starting from the lateral side of the thigh, penetrating thecortex of the femur bone 7 and eventually reaching the cortex of thecaput femur 5 from the inside thereof, penetrating said cortex andentering into the hip joint. After the creation of the hole 82 in thefemur bone 7 the first sealing member 84 is inserted into the hip jointthrough the hole 82 using a surgical instrument 88 adapted therefor, asshown in FIG. 44 c.

FIG. 43 a,b,c shows the surgical instrument adapted to insert a mould 81and/or a first and second sealing member 84,86 into the hip joint of ahuman patient through a hole 18 in the pelvic bone 9 or a hole 82 in thefemur bone 9.

FIG. 43b shows a section of the surgical instrument 83,85,88 comprisinga tube like element for housing of the mould 81 and/or said first andsecond sealing members 84,86. A piston 89 used to transport said mould81 and/or first and second sealing members 84,86 into the hip joint of ahuman patient is also shown.

FIG. 43c shows a surgical instrument 83,85,88 adapted to insert a mould81 and/or a first and second sealing member 84,86 into the hip joint ofa human patient, the second embodiment further comprises a flexible orbent part 91 improving the reach of the surgical instrument.

After the steps of providing a mould 81 or a sealed space 87, fluid isinjected into said mould 81 or into said sealed space 87 through thehole 18 in the pelvic bone 9 or the hole 82 in the femur bone 7.

FIG. 44 shows a lateral section of the human body wherein an injectingmember 92 injects a fluid into a mould 81 in the hip joint through ahole 18 in the pelvic bone 9 from the opposite side from acetabulum 8.

FIG. 45 shows the hip joint in section wherein an injecting member 92injects a fluid 93 into a sealed area 87 in the hip joint through a hole18 in the pelvic bone 9 from the opposite side from acetabulum 8. Saidsealed area 87, being sealed by a first 84 and second 86 sealing member.The injecting member 92 comprises a piston 94 that pushes said fluid 93into the sealed area 87.

FIG. 46 shows the hip joint in section wherein an injecting member 92injects a fluid 93 into a mould 81 in the hip joint through a hole 82 inthe femur bone 7. The injecting member 92 comprises a piston 94 thatpushes said fluid 93 into the mould 81.

FIG. 47 shows the hip joint in section wherein an injecting member 92injects a fluid 93 into a sealed area 87 in the hip joint through a hole82 in the pelvic bone 9 from the opposite side from acetabulum 8. Saidsealed area 87, being sealed by at least a first 84 sealing member. Theinjecting member 92 comprises a piston 94 that pushes said fluid 93 intothe sealed area 87.

FIG. 48 shows the sealed area 87, sealed by the first 84 and second 86sealing member together with the caput femur 5 and the pelvic bone 9. Afluid adapted to harden 93 has been injected into said sealed area, andafter the hardening of said fluid it provides at least one hip jointsurface.

After the injecting member 92 has injected a fluid 93 into a mould 81 ora sealed are 87 it is being retracted from the area.

The mould 81 and the first and second sealing members 84,86 according toany of the embodiments can further be adapted to be resorbable by thehuman body or to melt after they have served their purpose.

After at least one hip joint surface has been provided through a hole 18in the pelvic bone 9, in accordance with any of the embodiment above,said hole 18 needs to be closed.

FIG. 49 shows the hip joint of a human patient in section wherein a boneplug 31 is placed in the hole 18 in the pelvic bone 9 to close said hole18. According to a first embodiment the artificial acetabulum surface 65comprises supporting members 94 which carries the load placed on theacetabulum 8 from weight of the human patient through the contact withthe caput femur 5. Said supporting members can be adapted to bedisplaceable 97 supporting members. The bone plug 31 can be attached tothe artificial acetabulum surface 11 and/or the pelvic bone 9 by meansof bone cement, adhesive, screws, form fitting, welding, sprints, bandor some other mechanical connecting member.

FIG. 50 shows the hip joint of a human patient in section wherein thebone plug 31 placed in the hole 18 in the pelvic bone 9 is furthersupported by supporting means 96 placed between the bone plug 31 and thepelvic bone 9 on the opposite side from acetabulum 8 using at lest oneof: bone cement, adhesive, screws, form fitting, welding, sprints, bandor some other mechanical connecting member.

FIG. 51 shows a bone plug 31 or a prosthetic part 98 comprising severaldisplaceable supporting members adapted to carry the load placed on theacetabulum 8 from weight of the human patient through the contact withthe caput femur 5. The displaceable parts 97 are displaced into acorresponding part in or at the edge of the hole 18 in the pelvic bone9.

According to a second embodiment the closing of the hole 18 in thepelvic bone is done by means of a prosthetic part 98. FIG. 52a shows theprosthetic part 98 being inserted into a hole 18 in the pelvic bone 9from the opposite side from acetabulum 8. According to one embodimentthe prosthetic part 98 comprises supporting members 99 adapted tocorrespond with sections 100 of the hole 18 in the pelvic bone 9. Afterthe prosthetic part 98 has been inserted into said hole 18 in the pelvicbone 9 it is rotated so that the supporting members 99 comes in contactwith the pelvic bone 9 and can carry the load placed on the acetabulum 8from weight of the human patient through the contact with the caputfemur 5. Said prosthetic part 98 could also be adapted to serve asartificial acetabulum surface 65 according to any of the above mentionedembodiments.

FIG. 52b shows the prosthetic part 98 when rotated to carry the loadplaced on the acetabulum 8 from weight of the human patient through thecontact with the caput femur 5.

FIG. 52c shows the hip joint of a human patient in section wherein theprosthetic part 98 closes the hole 18 in the pelvic bone 9 and carriesthe load placed on the acetabulum 8 from weight of the human patientthrough the contact with the caput femur 5 by means of the supportingmembers 99. The prosthetic part 98 can further be fixated to the pelvicbone 9 by means of bone cement, adhesive, screws, form fitting, welding,sprints, band or some other mechanical connecting member.

FIG. 53a shows the hip joint of a human patient in section wherein boneplug 31 or prosthetic part 98 is attached to the pelvic bone 9 by meansof screws 101 placed from the opposite side from acetabulum 8. Thescrews 101 are possible to place in different angles depending on reachor need for support.

FIG. 53b shows the hip joint of a human patient in section wherein boneplug 31 or prosthetic part 98 is attached to the pelvic bone 9 by meansof a plate 102 at least partly covering said bone plug 31 or prostheticpart 98. According to a first embodiment the plate 102 is attached tothe pelvic bone 9 by means of screws 103 placed from the opposite sidefrom acetabulum 8. However it is also conceivable that said screws 103can be replaced or assisted by bone cement, adhesive, form fitting,welding, sprints, band or some other mechanical connecting member.

FIG. 53c shows the hip joint of a human patient in section wherein twobone plugs 31 or prosthetic parts 98 are attached to the pelvic bone 9by means of a plate 102 at least partly covering said bone plugs 31 orprosthetic parts 98. According to a first embodiment the plate 102 isattached to the pelvic bone 9 by means of screws 103 placed from theopposite side from acetabulum 8. However it is also conceivable thatsaid screws 103 can be replaced or assisted by bone cement, adhesive,form fitting, welding, sprints, band or some other mechanical connectingmember. FIG. 53c also shows the provided artificial acetabulum surface65.

FIG. 53d shows the hip joint of a human patient in section wherein twoholes 18 in the pelvic bone has been covered by means of a fluidinjected into said holes 18, through sealing members 104, said fluid 93being adapted to harden. Further more a plate 102 has been provided atleast partly covering said holes 18. According to a first embodiment theplate 102 is attached to the pelvic bone 9 by means of screws 103 placedfrom the opposite side from acetabulum 8. However it is also conceivablethat said screws 103 can be replaced or assisted by bone cement,adhesive, form fitting, welding, sprints, band or some other mechanicalconnecting member. FIG. 53d also shows the provided artificialacetabulum surface 65, and the provided artificial caput femur surface45.

FIG. 54a shows an injecting member 105 for injecting a fluid adapted toharden 93, preferably bone cement or adhesive to be used as support inthe closing of the hole 18 in the pelvic bone 9. The injecting member105 comprises a piston 94 that pushes said fluid 93 the area where it iswanted.

FIG. 54b shows the injecting member 105 as it is inserted through theskin 106 of a human patient in the surgical or laparoscopic/arthroscopicmethod, and is further placed in connection with the hip joint throughthe hole 18 in the pelvic bone 9. The injecting member 105 is adapted toinject a fluid 93 adapted to harden.

FIG. 55 shows the injecting member 105 according to any of theembodiments above, adapted to inject fluid 93 into a mould 81, a sealedarea 87 or a connecting area between the pelvic bone 9 and a prostheticpart, the pelvic bone 9 and a bone plug 31 or the caput femur 5 and aprosthetic part. Said injecting member comprises a container 107 adaptedto hold a fluid for injection. According to a first embodiment saidcontainer comprises two compartments 108 a,b adapted to hold twodifferent fluids, said fluids being adapted to harden when mixed. In theembodiment when the container 107 is adapted to hold two fluids, it isconceivable that the injecting member 105 further comprises a mixingmember 109 wherein said two fluids are being mixed before injection.According to a second embodiment (not shown) said container 107 isadapted to keep said fluid sterile. According to a third embodiment (notshown) said container 107 is adapted to keep said fluid cold andaccording to a fourth embodiment (not shown) said container 107 isadapted to keep said fluid in a dark environment. Furthermore acombination of the above mentioned embodiments is conceivable.

After the step of closing the hole in the pelvic bone of the humanpatient is concluded all instruments are refracted and the final step ofthe surgical or laparoscopic/arthroscopic method is performed. The finalstep comprises suturing or stapling the affected tissue and finallysuturing or stapling the skin of the human patient.

FIG. 56a shows the step of suturing 110 or stapling 111 the skin 106 ofthe human patient in the surgical method, whereas FIG. 56b shows thestep of suturing 110 or stapling 111 the skin 106 of the human patientin the laparoscopic/arthroscopic method.

Please note that any embodiment or part of embodiment as well as anymethod or part of method could be combined in any way. All examplesherein should be seen as part of the general description and thereforepossible to combine in any way in general terms.

1-52. (canceled)
 55. A surgical or arthroscopic method for resurfacingat least one surface of a hip joint of a human patient, using a medicaldevice comprising an artificial hip joint surface, wherein the hip jointsurface comprising an acetabulum surface and a caput femur surface, saidmethod comprising the steps of: creating at least one hole passing intothe hip joint, dissecting and preparing the hip joint, introducing atleast one artificial hip joint surface, comprising at least one of anartificial acetabulum surface and an artificial caput femur surface,wherein said at least one artificial hip joint surface, comprising afirst sealing member, creating a sealed hollow space between said firstsealing member and one of the acetabulum surface or said artificialacetabulum surface and one of the caput femur surface or said artificialcaput femur surface, selecting at least one artificial hip jointsurface, injecting a material into said hollow space.
 56. A surgical orarthroscopic method according to claim 55, wherein said at least oneartificial hip joint surface further comprises a second sealing member,wherein the step of creating a sealed hollow space also comprise thesteps of: sealing said hole passing into the hip joint with said secondsealing member, and wherein the step of injecting a material into saidhollow space, comprises injecting through said second sealing member.57. A The surgical or arthroscopic method according to claim 55, whereinsaid first sealing member comprises an opening, wherein the step ofinjecting into said sealed hollow space also comprise the steps of:injecting a material into said hollow space through said opening in saidfirst sealing member.
 58. The method according to claim 55, wherein thestep of injecting a material into said hollow space, comprises the stepof creating an artificial hip joint surface
 59. The method according toclaim 55, wherein the step of injecting a material into said hollowspace, comprises creating an intermediate artificial hip joint surfacesplaced between an artificial caput femur surface and an artificialacetabulum surface.
 60. The method according to claim 55, wherein thestep of creating at least one hole passing into the hip joint furthercomprises the step of creating two or more holes.
 61. The methodaccording to claim 55, further comprising the step of viewing with acamera through said hole.
 62. The method according to any claim 55,further comprising the step of using one hole for introducing adissecting tool into the hip joint.
 63. The method according to claim55, further comprising the step of using one hole for introducing acirculating clear fluid into the hip joint, thus allowing a better viewwith said camera.
 64. The method according to claim 55, furthercomprising the step of removing said sealing member.
 65. The methodaccording to claim 55, wherein said sealing member is resorbed by thehuman body.
 66. The method according to claim 55, wherein said sealingmember melts after having served its purpose as sealing member.
 67. Themethod according to claim 55, further comprising the step of removingsaid sealing member after it have served its purpose as sealing member.68. The method according to claim 55, wherein the step of dissecting andpreparing the hip joint, further comprises the step of reaming theacetabulum and/or the caput femur.
 69. The method according to claim 55,wherein the step of dissecting and preparing the hip joint, furthercomprises the step of reaming the acetabulum and/or the caput femurusing an expandable reamer.
 70. The method according to claim 55,wherein said material is a biocompatible material.
 71. The methodaccording to claim 55, wherein said injected into contact with at leastsaid first sealing member.
 72. The method according to claim 55, furthercomprising the step of said material changing from a fluid state to asolid state after said injection in said hollow space.
 73. The methodaccording to claim 55, wherein said have a surface tolerating wear andpressure in a hip joint surface, when said material is in a solid state.74. The method according to claim 55, further comprising the step ofintroducing said first sealing member into the hip joint through a holein the pelvic bone. 75-77. (canceled)